| NPI | 1013094119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WV 19030) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 19030) |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: WV 19030) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-07-21 |